Child and adolescent suicide: epidemiology, risk factors, and approaches to prevention

The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders

This study investigated the phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with ASD (N = 102; range 7-16 years). The presence of suicidal thoughts and behavior was assessed through the Anxiety Disorders Interview Schedule-Child and Parent Versions. Children and parents completed measures of anxiety severity, functional impairment, and behavioral and emotional problems. Approximately 11 % of youth displayed suicidal thoughts and behaviors. Children with autism were more likely to have suicidal thoughts and behaviors whereas children with Asperger's disorder were less likely. Suicidal thoughts and behaviors were associated with the presence of depression and post-traumatic stress disorder. Overall, results suggest that suicidal thoughts and behaviors are common in youth with ASD, and may be related to depression and trauma.

The Association between Non-Medical Prescription Drug Use and Suicidal Behavior among United States Adolescents

Adolescence represents a vulnerable time for the development of both drug use/abuse and mental illness. Although previous research has substantiated a relationship between drug use and suicidal behavior, little research has examined this relationship with non-medical prescription drug use. Given the growing prevalence of non-medical prescription drug use (NMPDU) among adolescents, this study explored the association between NMPDU and suicidal behavior. Nationally representative data were derived from 16, 410 adolescents who completed the 2009 National Youth Risk Behavior Survey. Approximately 19.8% of participants reported lifetime NMPDU. NMPDU was associated with significantly increased odds of suicidal behavior (P < 0.01), with seriously considering attempting suicide and making a plan about attempting suicide representing the strongest correlates for males and females. Results suggest the importance of 1) continued reinforcement of drug education programs in high school begun at earlier ages and 2) mental health care and screenings among adolescents.

Community-based surveillance and case management for suicide prevention: an American Indian tribally initiated system

The National Strategy for Suicide Prevention highlights the importance of improving the timeliness, usefulness, and quality of national suicide surveillance systems, and expanding local capacity to collect relevant data. This article describes the background, methods, process data, and implications from the first-of-its-kind community-based surveillance system for suicidal and self-injurious behavior developed by the White Mountain Apache Tribe with assistance from Johns Hopkins University. The system enables local, detailed, and real-time data collection beyond clinical settings, with in-person follow-up to facilitate connections to care. Total reporting and the proportion of individuals seeking treatment have increased over time, suggesting that this innovative surveillance system is feasible, useful, and serves as a model for other communities and the field of suicide prevention.

Interpersonal stress, not depression or hopelessness, predicts suicidality in university students in Macao

OBJECTIVES

Joiner's Interpersonal Theory of Suicide, which states that an individual will desire death when they perceive themselves to be a burden to others, and experience social isolation, has received much support, but has not been directly assessed in non-Eurocentric individuals.

METHODS

Joiner's Interpersonal Needs Questionnaire (measuring both perceived burdensomeness and thwarted belongingness) and measures of depression, hopelessness, gender, relationship status and region of residence were evaluated as risk factors for suicidality after controlling for response biases. Participants were 273 undergraduate university students of Chinese ethnicity between the ages of 17 and 23 years in Macao.

RESULTS

The predictors in sum distinguished between the presence and absence of suicidality (χ(2) = 62.759, p < .01). Perceived burdensomeness (p < .01) and relationship status (p < .01) made significant contributions to the presence of suicidality. Low internal consistency prevented thwarted belongingness from being assessed as a risk factor.

CONCLUSIONS

Interpersonal variables may account for the seemingly disparate risk factors for suicide.

The association between suicidality and Internet addiction and activities in Taiwanese adolescents

OBJECTIVE

The aims of this cross-sectional study were to examine the associations of suicidal ideation and attempt with Internet addiction and Internet activities in a large representative Taiwanese adolescent population.

METHODS

9510 adolescent students aged 12-18 years were selected using a stratified random sampling strategy in southern Taiwan and completed the questionnaires. The five questions from the Kiddie Schedule for Affective Disorders and Schizophrenia were used to inquire as to the participants' suicidal ideation and attempt in the past one month. The Chen Internet Addiction Scale was used to assess participants' Internet addiction. The kinds of Internet activities that the adolescents participated in were also recorded. The associations of suicidal ideation and attempt with Internet addiction and Internet activities were examined using logistic regression analysis to control for the effects of demographic characteristics, depression, family support and self-esteem.

RESULTS

After controlling for the effects of demographic characteristics, depression, family support and self-esteem, Internet addiction was significantly associated with suicidal ideation and suicidal attempt. Online gaming, MSN, online searching for information, and online studying were associated with an increased risk of suicidal ideation. While online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt, watching online news was associated with a reduced risk of suicidal attempt.

CONCLUSIONS

The results of this study indicated that adolescents with Internet addiction have higher risks of suicidal ideation and attempt than those without. Meanwhile, different kinds of Internet activities have various associations with the risks of suicidal ideation and attempt.

Gender differences in methods of suicide attempts and prevalence of previous suicide attempts

OBJECTIVE

Suicide attempts are important predictors of completed suicide. Adolescents admitted to the emergency room of a large university hospital in Bern after a suicide attempt during the years 2004-2010 were prospectively assessed for methods of suicide attempt.

METHOD

Adolescents (N = 257; 66.5% female; age 14-21 years), presenting after a suicide attempt, were assessed with the WHO/EURO Multicentre Study on Parasuicide assessment tool.

RESULTS

Males more often used jumping from a high place (14% vs. 4.6% in females, p < .05) and less often intoxication (36% vs. 71.3%, p < .01). At least one previous suicide attempt was reported in 100 patients (44.4%; more females than males: Cramer-V = 0.21; p = .002). Of these, 35 adolescents did not present to this hospital or not at all for a previous suicide attempt.

CONCLUSIONS

The present study is the first to examine methods of suicide attempts according to the ICD-10 X codes in this age group. Gender differences were observed. Because a relevant number of patients did not present to the same hospital or not at all for a previous suicide attempt, studies on pathways to care of adolescents after their first suicide attempt are important for early detection and intervention strategies.

Suicide attempts by deliberate self-poisoning in children and adolescents

AIM

The objective of the study was to examine the toxicological characteristics of suicide attempts by deliberate self-poisoning in children and adolescents.

METHOD

From the Toxicological Information Centre's database, the inquiries due to the suicide attempts in children (9-13 years old) and adolescents (14-18 years old) were evaluated.

RESULTS AND CONCLUSIONS

From 10,492 calls concerning suicide attempts, 2393 concerned children and adolescents. Most suicide attempts were attempted in spring (31.3%). Among the toxic agents, drugs were used in 97.8% cases. The most frequent ingestions appeared using drugs affecting the nervous system and anti-inflammatory non-steroids. The dose was evaluated as toxic in 73.4%, severely toxic in 3.0% and unknown in 11.2% cases. Only one in 10 children used a non-toxic dose. Girls, more frequently than boys (13.2% vs. 8.9%), used non-toxic doses. The symptoms of moderate and severe intoxications were present in 10.5% of the cases. Poison centre consultation was accessed within the first hour after the ingestion in one-fifth of the patients. In both age groups, the severity of the intoxication was greater among elder males who reached the medical facilities later than 4 h after the poisoning. The combinations of three or more drugs affecting central nervous system were present in the most severe cases.

An epidemiological survey of the suicide incidence trends in the southwest iran: 2004-2009

BACKGROUND

Elimination of suicide attempts is impossible, but they can be reduced dramatically by an organized planning. The present study aimed to survey the suicide trends in Fars province (Iran), during 2004-2009 to better understand the prevalence and status of suicide.

METHODS

This survey was a cross-sectional study. The demographic data were collected from the civil status registry between 2004 and 2009. Suicide and suicide attempt data were collected of three sources including the affiliated hospitals of Shiraz University of Medical Sciences, mortality data of Vice Chancellery of Health in Fars province and data from forensic medicine. Then, they were analyzed by Excel and SPSS. Chi-square and regression analyses were used for data analysis.

RESULTS

During the study, 10671 people attempted suicide, of which 5697 (53%) were women and 4974 (47%) were men. Among them, 1047 people (9.8%) died, of which 363 (34%) were women and 679 (64%) were men. There was a significant relationship between gender and fatal suicide. The mean suicide attempt for both genders was 53 per 100,000 and 49, 57 for men and women, respectively. The trends in the incidence of Suicidal attempts were decreasing.

CONCLUSION

Without implementing effective preventive measures, the health care system in Iran will face a further burden of fatal suicides among young people. Therefore; enhancing the primary health care and specialized mental health services for those with unsuccessful suicide attempts can effectively reduce the burden of suicide.

Suicidal childhood deaths with firearms in Antalya, Turkey

The purpose of this study was to determine the characteristics of suicidal childhood deaths with the use of firearms that occurred from 2000 to 2009 in Antalya. The autopsy reports of the Antalya branch of the Turkish Forensic Medicine Council and judicial records were reviewed retrospectively. There were 60 suicidal deaths between 0 and 18 years of age. Firearms were used in 20 cases (11 males, 9 females). The shotgun (n = 15) was the most frequently used weapon. The site of bullet entries were the chest (n = 6), abdomen (n = 5), right temple (n = 5), mouth (n = 2) and neck (n = 2). Most suicides (n = 16) were in the home. In contrast to many other studies, the most frequently used weapon for suicides was the shotgun in this study.

Suicidality among trans people in Ontario: Implications for social work and social justice

While transgender and transsexual (trans) communities have been documented to experience high rates of suicidality, little attention has been paid to how this may vary based on experiences of social injustice. Using survey data from the Trans PULSE Project (n=433), we estimated that suicidal thoughts were experienced by 36% of trans Ontarians over the past year, and that 10% attempted suicide during that time. Moreover, we documented that youth and those experiencing transphobia and lack of support are at heightened risk. Suicidality varied greatly by medical transition status, with those who were planning to transition sex, but who had not yet begun, being most vulnerable. Recommendations are made for improving wellbeing in trans communities, through policy advocacy, service provision, access to transition care, and fostering accepting families and communities.

Dating violence, psychological distress, and attempted suicide among female adolescents in the juvenile justice system

The prevalence of mental illness and suicide among female adolescents involved with the juvenile justice system is alarmingly high and there is a need to identify risk factors that may be amenable to intervention. This study examined the independent association between dating violence and poor mental health (psychological distress and attempted suicide) among 305 female adolescents involved with the juvenile justice system in Nevada. Overall, 28% of the sample met the criteria for clinically significant psychological distress and 18% had attempted suicide with intent to die. After controlling for well-established risk factors such as sexual orientation, childhood abuse, and substance abuse, dating violence remained independently associated with psychological distress and attempted suicide. These findings suggest that mental health programming for this population may be more effective if it includes a focus on dating violence.

Cognitive correlates of serious suicidal ideation in a community sample of adolescents

BACKGROUND

Studies indicate that a dysfunctional attributional style, problem-solving deficits and hopelessness place youths at risk of developing suicidal thoughts and engaging in suicidal behaviour. However, in the realm of suicidality in adolescent, no study has examined the linkages between these three cognitive variables and suicidal ideation in non-clinical samples while taking into account the moderating role of gender on the relationships and controlling for depression.

METHODS

In this community study of 712 adolescents 14-18 years of age, through a multivariate approach, the interaction between the cognitive variables, depression and gender was examined with depression controlled in the analyses.

RESULTS

Problem-solving deficits and hopelessness proved predictive of such ideation whether or not depressive symptoms were controlled in the analyses. Negative problem orientation/avoidant style was more predictive of ideation in boys than in girls. On the other hand, hopelessness was more predictive for girls than boys.

LIMITATIONS

Results were based on a convenience community sample of adolescents and a cross-sectional survey.

CONCLUSIONS

Results suggest that a unique explanatory model of the suicide process in adolescence that fails to take account of gender would be ill informed. Suicide prevention strategies should be differentiated according to gender with a stronger emphasis in hopelessness in female adolescents, and problem-solving deficits in male adolescents.

Predictors of suicidal ideation in late childhood and adolescence: a 5-year follow-up of two nationally representative cohorts in the Republic of Korea

This study explores the trajectory of suicidal ideation in childhood and adolescence and identifies its strong predictors. Secondary data obtained from two nationally representative cohorts of South Korean youth were longitudinally analyzed using frequencies, percentages, and discrete time survival analysis. This study revealed an increase in the occurrence of suicidal ideation in adolescence, a higher prevalence of suicidal ideation among females than among males, and differences in predictors of suicide ideation by developmental stages and gender. The results suggest that multifaceted factors specific to developmental stages and gender should be simultaneously considered to diminish the occurrences of suicidal ideation.

Involvement in bullying and suicidal ideation in middle adolescence: a 2-year follow-up study

The objective of the study was to ascertain whether involvement in bullying increases the risk for subsequent suicidal ideation. A total of 2,070 Finnish girls and boys aged 15 were surveyed in the ninth grade (age 15) in schools, and followed up 2 years later in the Adolescent Mental Health Cohort Study. Involvement in bullying was elicited at age 15 by two questions focusing on being a bully and being a victim of bullying. Suicidal ideation was elicited by one item of the short Beck Depression Inventory at age 17. Baseline depressive symptoms and externalizing symptoms, age and sex were controlled for. Statistical analyses were carried out using cross-tabulations with Chi-square/Fisher's exact test and logistic regression. Suicidal ideation at age 17 was 3-4 times more prevalent among those who had been involved in bullying at age 15 than among those not involved. Suicidal ideation at age 17 was most prevalent among former victims of bullying. Being a victim of bullying at age 15 continued to predict subsequent suicidal ideation when depressive and externalizing symptoms were controlled for. Being a bully at age 15 also persisted as borderline significantly predictive of suicidal ideation when baseline symptoms were controlled for. Findings indicate adolescent victims and perpetrators of bullying alike are at long-term risk for suicidal ideation.

Characterization of adolescent prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-related Surveillance (RADARS(®)) System

OBJECTIVE

To describe the characteristics and health effects of adolescent (age 13-19 years) prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS(®)) System.

METHOD

Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all intentional exposures from 2007 through 2009 were used to describe adolescent prescription opioid (oxycodone, fentanyl, hydrocodone, hydromorphone, morphine, methadone, buprenorphine, and tramadol) and stimulant (methylphenidate and amphetamines) exposures.

RESULTS

A total of 16,209 intentional adolescent exposures to prescription drugs were identified, 68% to opioids and 32% to stimulants. The mean age was 16.6 years (SD ± 1.7 years). Slightly more than half (52.4%) of drug mentions involved females. The five most frequently misused or abused drugs were hydrocodone (32%), amphetamines (18%), oxycodone (15%), methylphenidate (14%), and tramadol (11%). Of all exposures, 38% were classified as suspected suicidal. Of adolescents who intentionally exposed themselves to prescription drugs, 30% were treated in a health care facility, 2,792 of whom were admitted to the hospital, including 1,293 to the intensive care unit. A total of 17.2% of intentional exposures were associated with no effect, 38.9% minor effects, 23.3% moderate effects, 3.6% major effects, and 0.1% were associated with death. Oxycodone and methadone were associated with the most deaths. No deaths were associated with exposures to stimulants.

CONCLUSIONS

Prescription drug misuse and abuse poses an important health problem and results in thousands of hospitalizations of adolescents per year. Further work is needed to develop focused interventions and educational programs to prevent prescription drug abuse and misuse by adolescents.

Childhood suicide attempts with acetaminophen in Denmark: Characteristics, social behaviour, trends and risk factors

Aims: To explore: (1) The relationship between children admitted to our paediatric department as a result of suicide attempts with acetaminophen and their parents and friends. (2) The extent to which the children had attempted to speak to their parents about their problems before their suicide attempts. (3) The frequency of self-mutilation among children with suicidal behaviour. (4) The purposes and reasons for childhood suicide attempts. Methods: A retrospective case-control study based on medical records and in-hospital child psychiatric assessments at the Paediatric Department, Hillerød Hospital, Denmark, 2006–2011. Study group: 107 children, 11 to 15 years old. Control group: 59 age- and gender-matched children. Results: 43.5% experienced a dissociated parental relationship characterized by the inability to speak to their parents about any problems, compared with 2% in the control group. There was a significant association between a dissociated parental relationship and ‘the feeling of not being heard’ ( p = 0.004), the discovery of the suicide attempt ( p = 0.008), the reasons for the suicide attempt ( p = 0.006), academic school problems ( p = 0.03), and the child’s relationships with friends ( p = 0.02). Prior to their suicide attempts, 41.5% of the children had attempted to speak to their parents about their problems but felt that they were not heard. There was a significant association among ‘the feeling of not being heard’ and the purpose of the suicide attempt ( p = 0.002) and self-mutilation ( p = 0.002). Forty percent mutilated themselves repeatedly. Conclusions: A consistently impaired parent-child relationship, ‘the feeling of not being heard’, and self-mutilation are identifiable early risk factors that require increased concern and attention among professionals who work with children.

Role of impulsivity and other personality dimensions in attempted suicide with self-poisoning among children and adolescents

The objective of this study was to clarify the role of impulsivity and personality dimensions in attempted suicide among youth. The study included 120 youths who attempted suicide and 100 matched controls. Attempters of suicide had higher total scores and subscales of impulsivity than controls. They had higher novelty seeking, harm avoidance, and reward dependence scores, lower scores on persistence, self-directedness, and cooperativeness. A total of 77.5% of suicide attempters had psychiatric disorders compared to 2% of controls. Main factors predicting the occurrence of suicidal attempts were the presence of psychiatric disorder, impulsivity, stressful life events, and high reward dependence of suicide attempters. The study supports that impulsivity and personality traits play an important role in youth suicide independently or as a part of other interacting factors.

Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial

OBJECTIVE

To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.

DESIGN

Randomised, parallel group, superiority trial with blinded outcome assessment.

SETTING

Outpatient intervention at one location at Copenhagen University Hospital, Denmark.

PARTICIPANTS

Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days. We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions.

INTERVENTION

Case management through assertive outreach that provided crisis intervention and flexible problem solving. This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to standard treatment.

MAIN OUTCOME

Repeated suicide attempt and death by suicide, recorded in medical records and death register at 1-year follow-up.

RESULTS

243 patients were included. During 12 months of follow-up, 20/123 (16%) patients in the intervention group had been registered in hospital records with subsequent suicide attempt, compared with 13/120 (11%) in the control group (odds ratio 1.60, 95% confidence interval 0.76 to 3.38; P=0.22). By contrast, self reported data on new events showed 11/95 (12%) in the intervention group versus 13/74 (18%) in the control group (0.61, 0.26 to 1.46; P=0.27). By imputing missing data on the selfreported outcomes, we estimated 15/123 (12%) events in the intervention group and 23/120 (19%) in the control group (0.69, 0.34 to 1.43; P=0.32).

CONCLUSION

Assertive outreach showed no significant effect on subsequent suicide attempt. The difference in rates of events between register data and self reported data could indicate detection bias.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00700089.

The copycat phenomenon after two Finnish school shootings: an adolescent psychiatric perspective

BACKGROUND

Two school shootings with altogether 18 victims took place in Finland in November 2007 and September 2008. Homicides and suicides are both associated with the copycat phenomenon. The aim of the present study was to characterize adolescent copycats who had threatened to carry out a school massacre.

METHODS

The nation-wide study evaluated 77 13- to 18-year-old adolescents who were sent for adolescent psychiatric evaluations between 8.11.2007 and 30.6.2009, one of the reasons for evaluation being a threat of massacre at school. The medical files of the copycats were retrospectively analysed using a special data collection form. Data on demographics, family- and school-related issues, previous psychiatric treatment and previous delinquency, current symptoms, family adversities and psychiatric diagnoses were collected. The severity of the threat expressed and the risk posed by the adolescent in question were evaluated. The Psychopathy Checklist Youth Version was used to assess psychopathic traits.

RESULTS

All of the copycats were native Finns with a mean age of 15.0 years. Almost two thirds of them had a history of previous mental health treatment before the index threat. Almost two thirds of the copycats suffered from anxiety and depressive symptoms, and almost half of the sample expressed either suicidal ideation or suicidal plans. Behavioural problems including impulse control problems, aggressive outbursts, the destruction of property as well as non-physical and physical violence against other persons were common. The diagnosis groups highlighted were behavioural and emotional disorders, mood disorders as well as schizophrenia-related disorders. The prevalence of pervasive developmental disorders was high. Only one of the copycats was assessed as expressing high traits of psychopathy.

CONCLUSION

The copycats with school massacre threats were characterized with a high prevalence of mental and behavioural disorders. Like actual school shooters, they showed psychotic symptoms and traumatic experiences, but unlike the shooters, the copycats were not psychopathic.

Early predictors of suicidal ideation in young adults

OBJECTIVE

To identify early predictors of suicidal ideation in young adults, and to determine when specific time-varying determinants become important in predicting later suicidal ideation.

METHODS

Data were available for 877 participants in the Nicotine Dependence in Teens study, an ongoing prospective cohort of students aged 12 to 13 years at cohort inception in 1999. Time-invariant covariates included age, sex, mother's education, language, and self-esteem. Time-varying covariates included depression symptoms, family stress, other stress, alcohol use, cigarette use, and team sports. Independent predictors of past-year suicidal ideation at age 20 years were identified in 5 multivariable logistic regression analyses, one for each of grades 7, 8, 9, 10, and 11.

RESULTS

Eight per cent of participants (mean age 20.4 years [SD 0.7]; 46% male) reported suicidal ideation in the past year. In grade 7, none of the potential predictor variables were statistically significantly associated with suicidal ideation. In grade 8, participation in sports teams in and (or) outside of school protected against suicidal ideation (OR 0.6; 95% CI 0.4 to 0.8; P = 0.002). Depression symptoms in grades 9, 10, and 11 were independent predictors of suicidal ideation (OR 2.2; 95% CI 1.5 to 3.2, OR 1.6; 95% CI 1.0 to 2.5, and OR 1.9; 95% CI 1.1 to 3.4, respectively). No other variables were statistically significant in the multivariate models.

CONCLUSION

Depression symptoms as early as in grade 9 predict suicidal ideation in early adulthood. It is possible that early detection and treatment of depression symptoms are warranted as part of suicide prevention programs.

Not only body weight perception but also body mass index is relevant to suicidal ideation and self-harming behavior in Japanese adolescents

Whether a low body mass index (BMI) is directly associated with a high risk of suicidal ideation or self-harming behavior in adolescents is still inconclusive. This study has, therefore, evaluated the relevance of BMI to suicidal ideation and self-harming behavior after controlling for body weight perception (BWP) and other potential confounding factors. BMI, BWP, suicidal ideation, and self-harming behavior were all assessed using a self-report questionnaire administered to 18,104 Japanese adolescents. Potential confounding factors were also evaluated. The data were then analyzed using bivariate and multivariate logistic regression. Low BMI was associated with suicidal ideation and deliberate self-harm when controlling for sex, age, drug use, emotional distress, and BWP. Low BMI may be an independent risk factor for suicidal ideation and deliberate self-harming behavior in Japanese adolescents.

A longitudinal epidemiological comparison of suicide and other causes of death in Italian children and adolescents

The objective of the study is to evaluate temporal trends, gender effects and methods of completed suicide amongst children and adolescent (aged 10-17) when compared with temporal trends of deaths from other causes. Data were extracted from the Italian Mortality Database, which is collected by the Italian National Census Bureau (ISTAT) and processed by the Statistics Unit of National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) at the National Institute of Health (Istituto Superiore di Sanità). A total of 1,871 children and adolescents, age 10-17 years, committed suicide in Italy from 1971 to 2003 and 109 died by suicide during the last 3-year period of observation (2006-2008). The average suicide rate over the entire period of observation was 0.91 per 100,000; the rate was 1.21 for males and 0.59 for females. During the study period, the general mortality of children and adolescents, age 10-17 years, decreased dramatically, the average annual percentage change decrease was of -3.3% (95% CI -4.4 to -1.9) for males and -2.9% (95% IC -4.4 to -2.5) for females. The decrease was observed, for both genders, for all causes of deaths except suicide. For males, the most frequent method was hanging (54.5%), followed by shooting/fire arms (19.6%), falls/jumping from high places (12.7%); for females, the most frequent method, jumping from high places/falls, accounted for 35.7% of suicides during the whole study period. In conclusion, this study highlights that over the course of several decades suicide is a far less preventable cause of death as compared to other causes of death amongst children and adolescents. Our study demonstrated that suicide rates in adolescents are not a stable phenomenon over the 40 years period of study. It suggested that rates for males and females differed and varied in different ways during specific time periods of this study. National suicide prevention actions should parallel prevention measures implemented to reduce other causes of death.

Suicide in young Singaporeans aged 10-24 years between 2000 to 2004

The objective of this study was to understand the features of young suicide in order to contribute to suicide prevention efforts. In this article, the demographic, clinical, and suicide-related features of all cases of young suicide (aged 10-24 years) in Singapore for the years 2000-2004 are described. We also compared those who sought mental health services to those who did not. Overall, the suicide rate was 5.7 per 100, 000, with gender ratio of 1:1 and higher rates among ethnic Indians. Psychosocial stressors and suicide by jumping from height were common. Mental health service use was associated with unemployment, previous suicide attempts, family history of suicide, more use of lethal methods, lack of identifiable stressor, and less suicide notes. Suicide prevention efforts should promote awareness of suicide risks and access to mental health services.

[Suicidality and musical preferences: a possible link?]

Music is an important part of young people's lives. In this article, we attempt to answer two questions on the links between music et suicide. First, we examine if certain types of music favor suicidal process (ideation and acting out); and, secondly, we examine if music can constitute a tool to reduce the risk of suicide. Several factors possibly involved in links between musical preferences and the suicidal process are developed: the Velten effect and the musical mood induction procedure, the identification and the learning by imitation, the media influence as well as the individual characteristics. A multifactor approach is necessary to understand the complex and birectional links that unite musical preferences and suicide risk.

Israeli adolescents with ongoing exposure to terrorism: suicidal ideation, posttraumatic stress disorder, and functional impairment

In this study, we examined the relationships among terrorism exposure, functional impairment, suicidal ideation, and probable partial or full posttraumatic stress disorder (PTSD) from exposure to terrorism in adolescents continuously exposed to this threat in Israel. A convenience sample of 2,094 students, aged 12 to 18, was drawn from 10 Israeli secondary schools. In terms of demographic factors, older age was associated with increased risk for suicidal ideation, OR = 1.33, 95% CI [1.09, 1.62], p < .01, but was protective against probable partial or full PTSD, OR = 0.72, 95% CI [0.54, 0.95], p < .05; female gender was associated with greater likelihood of probable partial or full PTSD, OR = 1.57, 95% CI [1.02, 2.40], p < .05. Exposure to trauma due to terrorism was associated with increased risk for each of the measured outcomes including probable partial or full PTSD, functional impairment, and suicidal ideation. When age, gender, level of exposure to terrorism, probable partial or full PTSD, and functional impairment were examined together, only terrorism exposure and functional impairment were associated with suicidal ideation. This study underscores the importance and feasibility of examining exposure to terrorism and functional impairment as risk factors for suicidal ideation.

Childhood internalizing behaviour: analysis and implications

The concept of 'internalizing behaviour' reflects a child's emotional or psychological state and typically includes depressive disorders, anxiety disorders, somatic complaints and teenage suicide. Genetic and environmental causes have been largely implicated, although research continues to explore social etiological factors. Some research suggests females may be especially vulnerable to internalizing disorders, while data across ethnicities are somewhat variable. Regarding treatment, cognitive-behavioural therapies and use of pharmacological approaches (i.e. selective serotonin reuptake inhibitors) have both shown great promise in reducing symptoms of internalizing disorders. However, given the role of the social environment, prevention programmes aimed at reducing exposure to drugs, violence/abuse and environmental toxins are highly important. Internalizing disorders are associated with a host of deleterious outcomes (e.g. school drop-out, substance use and potentially suicide) as well as psychopathological outcomes (e.g. co-morbid anxiety or depression, externalizing disorders - including suicide). Children with mental health problems suffer educationally and are more likely to become entangled in the justice and welfare systems. Clearly, early treatment and prevention programmes for internalizing disorders need to be a priority from a public health perspective as well as from a family and community perspective.

Personality subtypes of adolescents who attempt suicide

Research suggests that personality pathology is shared among a considerable portion of adolescents presenting suicidal behavior. Furthermore, heterogeneity of personality within this population suggests a need to tease apart different types of attempters. The goal of this study was to identify the personality subtypes of adolescents who attempt suicide. We analyzed data on 266 adolescents, ages 13 to 18 years, with a history of at least one suicide attempt who were selected by treating clinicians for having at least some degree of personality problems. We used a Q-factor analysis to identify subtypes based on the Shedler-Westen Assessment Procedure-II for Adolescents (a 200-item measure of personality pathology used by clinically experienced observers). We derived six subtypes: Externalizing, Internalizing, Emotionally dysregulated, High functioning, Narcissistic, and Immature. The subtypes differed on measures of adaptive functioning, axis I and II pathology, and etiology. Adolescents who attempt suicide constitute a heterogeneous group, and they vary meaningfully on a measure of personality pathology. Interventions targeting suicidal behaviors in adolescents should consider individual differences.

Sex differences in childhood sexual abuse and suicide-related behaviors

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.

AUTISM Spectrum Disorders and Suicidality

The paper describes the suicidal ideation and behavior in a series of 26 adult psychiatric patients affected by Autism Spectrum Disorders (ASDs), the clinical features and the psychiatric comorbidity of patients presenting suicidal behavior, and the history of suicide or suicide attempt in their relatives. Two (7,7%) patients committed suicide. One (3.8%) patient attempted suicide twice, and one (3.8%) patient self-harmed by cutting his face and one finger of his hand with a razor. Eight (30.8%) patients presented suicidal ideation. Two (7.7%) patients had one relative who had attempted suicide, and two (7.7%) patients had one or more relatives who had committed suicide. Most patients with suicidal behavior or ideation presented psychotic symptoms. Although it is not clear whether the high suicidal risk is related with ASDs per se or with psychotic symptoms, a high index of suspicion is warranted in evaluating suicidal risk in patients affected by ASDs, whatever is their age, psychiatric comorbidity, and setting of visit.

Acute poisoning among children admitted to a regional university hospital in Northern Greece

OBJECTIVES

The aim of our study was to elucidate the current pattern of acute poisoning among children admitted to a regional University Hospital in the prefecture of Evros in Northern Greece. We also compared the obtained findings with those of two previous studies performed in the same region.

METHODS

Demographic and clinical data, management, and outcome of children with acute poisoning were recorded in our region, during the past 5-years (2005-2009, period C) and compared to similar studies carried out in the periods 1985-1989 (period A) and 1995-1999 (period B).

RESULTS

Comparison between the three periods showed that in period Athe lower incidence of children's acute poisoning (CAP) was observed. Also this revealed a 20%-reduction in the frequency of poisoning over the past 5-years (period C) compared to period B (p = 0.219), a significant increase in tobacco intoxication over the years (in the order A-C; p < 0.001 for comparisons of periods A and B, and periods B and C), while poisoning from insecticides-pesticides decreased (p < 0.001). The incidence of poisoning via salicylates significantly reduced from 9.7% in period A to 6.2% in period B, and further to 4.7% in period C (p = 0.016), whereas during the same periods poisoning via paracetamol increased from 2.3% to 5.1% and then to 10.4%, respectively (p < 0.001). Atrend toward a higher incidence of suicide attempt via poisoning was found during the three periods (from 3.0% in period A to 4.7% and 6.6%, in periods B and C, respectively; p = 0.049).

CONCLUSIONS

The frequency of acute poisoning among children has decreased over the past 5 years. The incidences of poisoning via paracetamol and tobacco, and attempted suicide have increased in recent years. Targeted and continuous educational preventive programs are mandatory.

The association between bullying and early stages of suicidal ideation in late adolescents in Greece

BACKGROUND

Bullying in schools has been associated with suicidal ideation but the confounding effect of psychiatric morbidity has not always been taken into account. Our main aim was to test the association between bullying behavior and early stages of suicidal ideation in a sample of Greek adolescents and to examine whether this is independent of the presence of psychiatric morbidity, including sub-threshold symptoms.

METHODS

5614 pupils 16-18 years old and attending 25 senior high schools were screened in the first phase and a stratified random sample of 2431 were selected for a detailed interview at the second phase. Psychiatric morbidity and suicidal ideation were assessed with the revised Clinical Interview Schedule (CIS-R) while bullying was assessed with the revised Olweus bully/victim questionnaire.

RESULTS

Victims of bullying behavior were more likely to express suicidal ideation. This association was particularly strong for those who were bullied on a weekly basis and it was independent of the presence of psychiatric morbidity (Odds Ratio: 7.78; 95% Confidence Interval: 3.05 - 19.90). In contrast, being a perpetrator ("bullying others") was not associated with this type of ideation after adjustment. These findings were similar in both boys and girls, although the population impact of victimization in the prevalence of suicidal ideation was potentially higher for boys.

CONCLUSIONS

The strong cross-sectional association between frequent victimization and suicidal ideation in late adolescence offers an opportunity for identifying pupils in the school setting that are in a higher risk for exhibiting suicidal ideation.

Psychopharmacology of depression in children and adolescents

Although much debate continues about the prevalence of depressive disorders in prepubertal children, depression clearly is common in adolescents, increasing rapidly throughout the teen years. All physicians who work with young patients must to be able to recognize and treat these disorders. This article provides a brief overview of depressive disorders in children and adolescence, including their clinical presentation, prevalence, etiology, course, and prognosis. Psychopharmacological treatment options are reviewed in detail, including practical information for medication management including patient education, making the decision to treat with medication, selection of specific medications, strategies for nonresponsive patients, and decisions about stopping medication.

[Psychiatric emergencies in childhood and adolescence]

OBJECTIVE

The prevalence of psychiatric disorders in childhood/adolescence is of 10-15%.The most frequent causes of psychiatric emergence attendances in this age are: behavioral disturbances, suicidal behavior, and depression.The objective of this study is to present the most relevant clinical issues and to guide the initial procedures of psychiatric emergencies in childhood/adolescence.

METHOD

Non-systematic review.

RESULTS

Relevant clinical issues for psychiatric emergency evaluation of children/adolescents are presented. Clinical presentations are divided in relevant groups of symptoms, due to its frequency and to its impact to patients and their families. Therefore, the following syndromes are presented: aggressive behavior, intoxication, suicidal behavior, psychoses, anxiety disorders, eating disorders, maltreatment against children/adolescents. The initial procedures recommended for each of these conditions are described.

CONCLUSION

Psychiatric emergencies in childhood/adolescence can be the re-agudization or a first crisis of a psychiatric disorder. The emergency evaluation's objectives are: to identify the diagnosis, the risks for the child/adolescent, the triggering and maintaining factors, and the presence of familiar and social support.

The associations between health risk behaviors and suicidal ideation and attempts in an urban Chinese sample of adolescents

BACKGROUND

To investigate the prevalence of suicidal ideation and attempts among adolescents in Guangzhou, China, and to explore the associations between health risk behaviors and suicidal behaviors.

METHODS

A two-stage stratified cluster sample design produced a representative sample of 12-19-year-old students who attended public middle schools in Guangzhou. Prevalence estimates and standard errors (SEs) of suicidal ideation and attempts were calculated using SUDAAN statistical software. Logistic regression was used to examine the associations between health risk behaviors and suicidal behaviors.

RESULTS

Overall, 17.25% of students reported suicidal ideation, and 3.04% reported suicidal attempts during the past 12 months. Almost all investigated health risk behaviors were significantly associated with suicidal ideation and attempts among adolescent females and males. In adjusted logistic regression analyses, physical fight was associated with suicidal attempts (adjusted odds ratio (AOR)=4.358; 95% confidence interval (CI)=1.080, 17.589), but not with suicidal ideation for females. Considering themselves overweight (AOR=1.257; 95%CI=1.082, 1.610) and current smoking (AOR=1.708; 95%CI=1.134, 4.605) were associated with suicidal ideation, but not with suicidal attempts for females. Among adolescent males, sad/hopeless (AOR=2.280; 95%CI=1.615, 3.219), current drinking (AOR=1.904; 95%CI=1.269, 2.857), and participating in vigorous physical activities > or = 3 times/week (AOR=0.639; 95%CI=0.477, 0.854) were associated with suicidal ideation, but not with suicidal attempts. Ever having had sexual intercourse was associated with suicidal attempts (AOR=2.588; 95%CI=1.125, 5.952), but not with suicidal ideation for males.

CONCLUSIONS

The associations of health risk behaviors with suicidal ideation and attempts varied by gender, and the correlates of suicidal ideation and suicidal attempts were different.

Preventing adolescent suicide: a community takes action

Suicide is the third leading cause of death for adolescents and young people in the United States. The etiology of suicide in this population has eluded policy makers, researchers, and communities. Although many suicide prevention programs have been developed and implemented, few are evidence-based in their effectiveness in decreasing suicide rates. In one northern California community, adolescent suicide has risen above the state's average. Two nurses led an effort to develop and implement an innovative grassroots community suicide prevention project targeted at eliminating any further teen suicide. The project consisted of a Teen Resource Card, a community resource brochure targeted at teens, and education for the public and school officials to raise awareness about this issue. This article describes this project for other communities to use as a model. Risk and protective factors are described, and a comprehensive background of adolescent suicide is provided.

Sexual orientation and gender identity in youth suicide victims: an exploratory study

OBJECTIVE

Our study was designed to explore additional outcome variables of a suicide case-control study to determine the association between sexual orientation and gender identity in suicide completion in children and adolescents.

METHOD

Fifty-five child and adolescent suicide victims and 55 community control subjects were assessed using semi-structured, proxy-based interviews and questionnaires regarding sexual orientation and gender issues, psychopathological diagnoses, and service use.

RESULTS

In our sample, no significant differences between suicide victims and control subjects were found regarding same-sex sexual orientation nor intimidation related to same-sex sexual orientation. Suicide victims with same-sex sexual orientation were more likely than suicide victims without same-sex sexual orientation, to meet criteria for anxiety disorders. Within the month preceding their deaths, these youth were more likely to have consulted a health professional, a psychiatrist, as well as having been hospitalized, and were more likely to have consulted a psychiatrist in the last year.

CONCLUSIONS

In our sample, same-sex sexual orientation and gender identity issues do not appear to be more prevalent among youth who die by suicide, compared with youth recruited from the general population, nor for same-sex sexual-related intimidation. While exhibiting comparable levels of general psychopathological diagnoses associated with suicide, suicide victims with same-sex sexual orientation were more likely to meet criteria for anxiety disorders and to have consulted mental health professionals before their deaths.

The psychological autopsy and determination of child suicides: a survey of medical examiners

This study explored the decision-making processes of medical examiners in the determination of child suicide. Ninety-four medical examiners completed a survey regarding those factors considered when making a child suicide determination, sources of information used, and considerations in accident vs. suicide classifications. No significant differences between groups of respondents were observed. Well-known risk factors such as suicide notes were considered by virtually all participants, but other risk factors (e.g., substance abuse) were not consistently taken into consideration. Common sources of information included informant interviews and review of records. Results indicate that age and evidence of intent are critical considerations in this process. Implications in terms of misclassification and prevention efforts are discussed.

Recent and lifetime utilization of health care services by children and adolescent suicide victims: a case-control study

OBJECTIVE

In the present paper we describe a case-control study on the utilization of health care services prior to suicide (across different time periods) among children and adolescents aged 11 to 18 years in the Province of Quebec, Canada and matched healthy controls.

METHOD

Utilization of services (i.e., contact with general practitioners, mental health professionals, psychiatrists and/or youth protection groups) was examined at different time periods in 55 child and adolescent suicide victims and 54 matched community controls using proxy-based interviews and questionnaires. In addition, we examined the rates of detection of psychopathology by health care professionals, the use of psychotropic medications and the subjects' compliance with treatment.

RESULTS

Although more than 90% of child and adolescent suicide completers in our sample suffered from mental disorders, a significant proportion of them were left without appropriate healthcare support (including psychiatric consultation) in the period preceding their suicide. Also, 20% of suicide completers and no control subject made prior suicide attempts. More specifically, over two-thirds of suicide completers had no treatment contact within the month prior to the completion, while only 12.7% (n=7) of them were in contact with psychiatric services during that same period. Moreover, 56.4% (n=31) of the suicide completers had not been diagnosed as having a mental disorder at the time of their death, and 54.5% of the subjects' that received treatment (12 out of 22) were considered poorly compliant or not compliant at all according to their medical/psychosocial records. Finally, we also found that females seemed to have more psychiatric and mental health service contacts in the past month, that subjects with depressive and anxious disorders received more psychiatric and general mental health services in the past year, and that past month hospitalization was more often associated with alcohol abuse and psychosis.

LIMITATIONS

Relatively small sample size, and cross-sectional design.

CONCLUSIONS

Our findings indicate the need for an overall increase in the rates of healthcare services delivered to young subjects at risk for suicide, as well as better training of health professionals in detecting and treating youth psychopathology.

Peer Victimization in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Link to Depressive Symptomatology, Anxiety Symptomatology and Suicidal Ideation

The present exploratory study examined the level of peer victimization, depressive symptomatology, anxiety symptomatology, and level of suicidal ideation among adolescents and young adults diagnosed with Asperger's Syndrome (AS). This cross-sectional study used a self-administrated mail questionnaire and a Web-based questionnaire. The study included two samples. The first sample used snowball sampling, beginning with parents of adolescents and young adults diagnosed with AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who accessed Web sites for parents and individuals diagnosed with Autism Spectrum Disorder. A total sample of 10 adolescents and young adults diagnosed with AS was obtained. The high proportion of respondents with scores above the cutoff point on the overt victimization and relational victimization scales suggests that these adolescents and young adults experienced high levels of victimization. Of the sample, 20 percent met criteria for a diagnosis of Major Depressive Disorder, 30 percent met criteria for Generalized Anxiety Disorder and 50 percent had clinically significant level of suicidal ideation.